Department of Surgery, Campus Virchow-Klinikum and Campus Charité Mitte, Charité - Universitätsmedizin Berlin, Augustenburger Platz 1, 13353, Berlin, Germany.
Department of General, Visceral, Vascular Surgery, Martin-Luther-Krankenhaus, Caspar-Theyß-Straße 27-31, 14193 Berlin, Germany.
HPB (Oxford). 2019 Jul;21(7):912-922. doi: 10.1016/j.hpb.2018.11.012. Epub 2019 Feb 4.
Surgical procedures in patients with underlying liver disease are still burdened by a high rate of postoperative morbidity, especially posthepatectomy liver failure (PHLF), ranging from 1.2 to 33.8%. The aim of this study was to investigate the prognostic value of volume/function analysis for the prediction of hepatectomy-related morbidity in patients with hepatocellular carcinoma.
Clinicopathological data were analysed in 261 patients who underwent liver resection for HCC between 2001 and 2014. Future liver remnant volume (FLRV) and future liver remnant function (FLRF) based on LiMAx test were obtained retrospectively. A subgroup analysis for high-risk patients with impaired liver function was conducted. Univariate and multivariate regression analysis was performed to identify risk factors for major complications, defined by Dindo ≥ IIIb and PHLF grade ≥ B.
In the total cohort, FLRF was independently associated with major complications. FLRV, resected liver volume, and FLRF were independent risk factors for PHLF. In a subgroup analysis of high-risk patients, FLRF was identified as the only independent risk factor for major complications and PHLF development.
These results suggest the superior value of FLRF to FLRV in predicting postoperative complications as well as PHLF in patients with chronic liver disease.
对于存在基础肝病的患者，外科手术仍然存在较高的术后发病率，尤其是肝切除术后肝衰竭（posthepatectomy liver failure，PHLF），发病率为 1.2%至 33.8%。本研究旨在探讨体积/功能分析对预测肝细胞癌肝切除术后相关发病率的预后价值。
对 2001 年至 2014 年间接受肝切除术治疗 HCC 的 261 例患者的临床病理数据进行分析。回顾性获得基于 LiMAx 试验的剩余肝体积（future liver remnant volume，FLRV）和剩余肝功能（future liver remnant function，FLRF）。对肝功能受损的高危患者进行亚组分析。采用单因素和多因素回归分析确定主要并发症（Dindo 分级≥IIIb 级和 PHLF 分级≥B 级）的危险因素。
在总队列中，FLRF 与主要并发症独立相关。FLRV、切除肝体积和 FLRF 是 PHLF 的独立危险因素。在高危患者的亚组分析中，FLRF 是主要并发症和 PHLF 发展的唯一独立危险因素。
这些结果表明，FLRF 在预测慢性肝病患者术后并发症和 PHLF 方面优于 FLRV。
